The fourth and final installment of this wellness series is by far the most difficult to control and maintain, but it is vital to your overall wellness.

Self-Esteem

One of the more complicated areas for the bipolar sufferer to delve into is the self-esteem. Often, someone with bipolar has a self-image that has been warped by years of irrational thinking or abuse. It is difficult to maintain a healthy outlook when your mind swims with thoughts and ideas that don't seem to connect. It's nearly impossible to have a clear picture of yourself under these circumstances. But, at some point along your path to wellness you should take the time to evaluate your self-esteem. Most of us can use a refresher from time to time; one that assures our look inward reflects back the truth in our soul. Here are a few ideas:

1. Don't begin any large self-improvement tasks unless you are stable. You're not going to make a dent in your outlook unless you are thinking rationally and are free of any psychosis.

2. Work with your treatment team on developing a course of action to build your self worth. They will, no doubt, be willing to work with you, offer advice on setting goals and even recommend reading materials and exercises.

3. Monitor your "self talk." This is the dialogue that plays inside your head. It will provide you with valuable insight on the health of your self-esteem. If you find that your "self talk" is mainly negative, use affirmations to change it. Don't underestimate the power of repeating positive phrases to yourself. What you say in your mind, about yourself, reflects the health of your self-esteem. We believe something to be true when we hear it repeatedly. If you are persistent enough with your affirmations you can produce a tremendous change in your attitude and learn to value yourself as a unique human being. Don't let spoofs on late night TV convince you not to try a very effective tool. Many books and tapes are available to help you get started.

4. Improve on organizational and stress management skills. Becoming more organized can help you value yourself to a greater degree. If you are constantly losing things or unable to locate things when needed you are setting yourself up to be criticized by others and turning that criticism inward. The same applies when handling stress. You will be rewarded in many ways if you can learn to handle everyday stress. Everyone falls prey to stress sometimes, but if you can eliminate minor stress then you will be better able to cope when faced with major stress. Books on organization and stress management are plentiful and some colleges even offer classes. I took a stress management class at the local community college about 13 years ago and I still use some of the skills I learned.

5. Therapy is a valuable tool in building your self worth. A therapist can guide you through problem areas that diminish your positive self-reflection. Nothing is better than having a trusted professional guide you in obtaining your goal of a healthy self esteem. Of course, you must let the therapist know that this is your goal because they cannot read your mind. Therapy, unfortunately, is not a viable option for everyone due to cost and managed health care restrictions. If you do have therapy as an option, take full advantage of your sessions and be 100% truthful. More than likely your therapist isn't going to hear something from you that he or she hasn't heard before. Most of the time our problems are not as unique as we like to think.

Cultivating a healthy self-esteem requires hard work and diligence, but it is well worth it in the long run. A strong, positive view of yourself can carry you through the roughest days, even if you are bipolar.

I'm sure other techniques and tools abound that have been successfully used by people trying to cope with this hideous creature that we call bipolar disorder. Unfortunately, I haven't been able to canvass the entire population and this is everything in my arsenal. Our wellness is a fragile balancing act taking place within the confines of our own minds. Most outsiders never see the cautious steps on the taut high wire of our daily lives. They are oblivious of the slow progress we are desperately trying to maintain, as we stand petrified between the point of insanity and the point of normalcy. All that most see are the lofty, manic leaps that soar beyond comprehension or the precarious tumbles that leave us hanging on by a mere thread with no safety net to catch us. I hope you will try some of the ideas in this series. The more you can include in your life, the stronger your thread becomes until it is finally a strong rope you can rely on to carry you from one obstacle to the next.